Consensus, dissensus and synergy between clinicians and specialist foundation models in radiology report generation

Radiology reports are an instrumental part of modern medicine, informing key clinical decisions such as diagnosis and treatment. The worldwide shortage of radiologists, however, restricts access to expert care and imposes heavy workloads, contributing to avoidable errors and delays in report delivery. While recent progress in automated report generation with vision-language models offer clear potential in ameliorating the situation, the path to real-world adoption has been stymied by the challenge of evaluating the clinical quality of AI-generated reports. In this study, we build a state-of-the-art report generation system for chest radiographs, \textit{Flamingo-CXR}, by fine-tuning a well-known vision-language foundation model on radiology data. To evaluate the quality of the AI-generated reports, a group of 16 certified radiologists provide detailed evaluations of AI-generated and human written reports for chest X-rays from an intensive care setting in the United States and an inpatient setting in India. At least one radiologist (out of two per case) preferred the AI report to the ground truth report in over 60$\%$ of cases for both datasets. Amongst the subset of AI-generated reports that contain errors, the most frequently cited reasons were related to the location and finding, whereas for human written reports, most mistakes were related to severity and finding. This disparity suggested potential complementarity between our AI system and human experts, prompting us to develop an assistive scenario in which \textit{Flamingo-CXR} generates a first-draft report, which is subsequently revised by a clinician. This is the first demonstration of clinician-AI collaboration for report writing, and the resultant reports are assessed to be equivalent or preferred by at least one radiologist to reports written by experts alone in 80$\%$ of in-patient cases and 60$\%$ of intensive care cases.

Towards Generalist Biomedical AI

Medicine is inherently multimodal, with rich data modalities spanning text, imaging, genomics, and more. Generalist biomedical artificial intelligence (AI) systems that flexibly encode, integrate, and interpret this data at scale can potentially enable impactful applications ranging from scientific discovery to care delivery. To enable the development of these models, we first curate MultiMedBench, a new multimodal biomedical benchmark. MultiMedBench encompasses 14 diverse tasks such as medical question answering, mammography and dermatology image interpretation, radiology report generation and summarization, and genomic variant calling. We then introduce Med-PaLM Multimodal (Med-PaLM M), our proof of concept for a generalist biomedical AI system. Med-PaLM M is a large multimodal generative model that flexibly encodes and interprets biomedical data including clinical language, imaging, and genomics with the same set of model weights. Med-PaLM M reaches performance competitive with or exceeding the state of the art on all MultiMedBench tasks, often surpassing specialist models by a wide margin. We also report examples of zero-shot generalization to novel medical concepts and tasks, positive transfer learning across tasks, and emergent zero-shot medical reasoning. To further probe the capabilities and limitations of Med-PaLM M, we conduct a radiologist evaluation of model-generated (and human) chest X-ray reports and observe encouraging performance across model scales. In a side-by-side ranking on 246 retrospective chest X-rays, clinicians express a pairwise preference for Med-PaLM M reports over those produced by radiologists in up to 40.50% of cases, suggesting potential clinical utility. While considerable work is needed to validate these models in real-world use cases, our results represent a milestone towards the development of generalist biomedical AI systems.

Constrained Causal Bayesian Optimization

We propose constrained causal Bayesian optimization (cCBO), an approach for finding interventions in a known causal graph that optimize a target variable under some constraints. cCBO first reduces the search space by exploiting the graph structure and, if available, an observational dataset; and then solves the restricted optimization problem by modelling target and constraint quantities using Gaussian processes and by sequentially selecting interventions via a constrained expected improvement acquisition function. We propose different surrogate models that enable to integrate observational and interventional data while capturing correlation among effects with increasing levels of sophistication. We evaluate cCBO on artificial and real-world causal graphs showing successful trade off between fast convergence and percentage of feasible interventions.

Generative models improve fairness of medical classifiers under distribution shifts

A ubiquitous challenge in machine learning is the problem of domain generalisation. This can exacerbate bias against groups or labels that are underrepresented in the datasets used for model development. Model bias can lead to unintended harms, especially in safety-critical applications like healthcare. Furthermore, the challenge is compounded by the difficulty of obtaining labelled data due to high cost or lack of readily available domain expertise. In our work, we show that learning realistic augmentations automatically from data is possible in a label-efficient manner using generative models. In particular, we leverage the higher abundance of unlabelled data to capture the underlying data distribution of different conditions and subgroups for an imaging modality. By conditioning generative models on appropriate labels, we can steer the distribution of synthetic examples according to specific requirements. We demonstrate that these learned augmentations can surpass heuristic ones by making models more robust and statistically fair in- and out-of-distribution. To evaluate the generality of our approach, we study 3 distinct medical imaging contexts of varying difficulty: (i) histopathology images from a publicly available generalisation benchmark, (ii) chest X-rays from publicly available clinical datasets, and (iii) dermatology images characterised by complex shifts and imaging conditions. Complementing real training samples with synthetic ones improves the robustness of models in all three medical tasks and increases fairness by improving the accuracy of diagnosis within underrepresented groups. This approach leads to stark improvements OOD across modalities: 7.7% prediction accuracy improvement in histopathology, 5.2% in chest radiology with 44.6% lower fairness gap and a striking 63.5% improvement in high-risk sensitivity for dermatology with a 7.5x reduction in fairness gap.

Differentially Private Diffusion Models Generate Useful Synthetic Images

The ability to generate privacy-preserving synthetic versions of sensitive image datasets could unlock numerous ML applications currently constrained by data availability. Due to their astonishing image generation quality, diffusion models are a prime candidate for generating high-quality synthetic data. However, recent studies have found that, by default, the outputs of some diffusion models do not preserve training data privacy. By privately fine-tuning ImageNet pre-trained diffusion models with more than 80M parameters, we obtain SOTA results on CIFAR-10 and Camelyon17 in terms of both FID and the accuracy of downstream classifiers trained on synthetic data. We decrease the SOTA FID on CIFAR-10 from 26.2 to 9.8, and increase the accuracy from 51.0% to 88.0%. On synthetic data from Camelyon17, we achieve a downstream accuracy of 91.1% which is close to the SOTA of 96.5% when training on the real data. We leverage the ability of generative models to create infinite amounts of data to maximise the downstream prediction performance, and further show how to use synthetic data for hyperparameter tuning. Our results demonstrate that diffusion models fine-tuned with differential privacy can produce useful and provably private synthetic data, even in applications with significant distribution shift between the pre-training and fine-tuning distributions.

Active Acquisition for Multimodal Temporal Data: A Challenging Decision-Making Task

We introduce a challenging decision-making task that we call active acquisition for multimodal temporal data (A2MT). In many real-world scenarios, input features are not readily available at test time and must instead be acquired at significant cost. With A2MT, we aim to learn agents that actively select which modalities of an input to acquire, trading off acquisition cost and predictive performance. A2MT extends a previous task called active feature acquisition to temporal decision making about high-dimensional inputs. Further, we propose a method based on the Perceiver IO architecture to address A2MT in practice. Our agents are able to solve a novel synthetic scenario requiring practically relevant cross-modal reasoning skills. On two large-scale, real-world datasets, Kinetics-700 and AudioSet, our agents successfully learn cost-reactive acquisition behavior. However, an ablation reveals they are unable to learn to learn adaptive acquisition strategies, emphasizing the difficulty of the task even for state-of-the-art models. Applications of A2MT may be impactful in domains like medicine, robotics, or finance, where modalities differ in acquisition cost and informativeness.

Affinity-Aware Graph Networks

Graph Neural Networks (GNNs) have emerged as a powerful technique for learning on relational data. Owing to the relatively limited number of message passing steps they perform -- and hence a smaller receptive field -- there has been significant interest in improving their expressivity by incorporating structural aspects of the underlying graph. In this paper, we explore the use of affinity measures as features in graph neural networks, in particular measures arising from random walks, including effective resistance, hitting and commute times. We propose message passing networks based on these features and evaluate their performance on a variety of node and graph property prediction tasks. Our architecture has lower computational complexity, while our features are invariant to the permutations of the underlying graph. The measures we compute allow the network to exploit the connectivity properties of the graph, thereby allowing us to outperform relevant benchmarks for a wide variety of tasks, often with significantly fewer message passing steps. On one of the largest publicly available graph regression datasets, OGB-LSC-PCQM4Mv1, we obtain the best known single-model validation MAE at the time of writing.

A Fine-Grained Analysis on Distribution Shift

Robustness to distribution shifts is critical for deploying machine learning models in the real world. Despite this necessity, there has been little work in defining the underlying mechanisms that cause these shifts and evaluating the robustness of algorithms across multiple, different distribution shifts. To this end, we introduce a framework that enables fine-grained analysis of various distribution shifts. We provide a holistic analysis of current state-of-the-art methods by evaluating 19 distinct methods grouped into five categories across both synthetic and real-world datasets. Overall, we train more than 85K models. Our experimental framework can be easily extended to include new methods, shifts, and datasets. We find, unlike previous work~\citep{Gulrajani20}, that progress has been made over a standard ERM baseline; in particular, pretraining and augmentations (learned or heuristic) offer large gains in many cases. However, the best methods are not consistent over different datasets and shifts.

Learning a Large Neighborhood Search Algorithm for Mixed Integer Programs

Large Neighborhood Search (LNS) is a combinatorial optimization heuristic that starts with an assignment of values for the variables to be optimized, and iteratively improves it by searching a large neighborhood around the current assignment. In this paper we consider a learning-based LNS approach for mixed integer programs (MIPs). We train a Neural Diving model to represent a probability distribution over assignments, which, together with an off-the-shelf MIP solver, generates an initial assignment. Formulating the subsequent search steps as a Markov Decision Process, we train a Neural Neighborhood Selection policy to select a search neighborhood at each step, which is searched using a MIP solver to find the next assignment. The policy network is trained using imitation learning. We propose a target policy for imitation that, given enough compute resources, is guaranteed to select the neighborhood containing the optimal next assignment amongst all possible choices for the neighborhood of a specified size. Our approach matches or outperforms all the baselines on five real-world MIP datasets with large-scale instances from diverse applications, including two production applications at Google. It achieves $2\times$ to $37.8\times$ better average primal gap than the best baseline on three of the datasets at large running times.